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Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis.

Publication ,  Journal Article
Bergin, SM; Wang, TY; Park, C; Rajkumar, S; Goodwin, CR; Karikari, IO; Abd-El-Barr, MM; Shaffrey, CI; Yarbrough, CK; Than, KD
Published in: Neurosurg Focus
June 2021

OBJECTIVE: The use of osteobiologics, engineered materials designed to promote bone healing by enhancing bone growth, is becoming increasingly common for spinal fusion procedures, but the efficacy of some of these products is unclear. The authors performed a retrospective, multi-institutional study to investigate the clinical and radiographic characteristics of patients undergoing single-level anterior cervical discectomy with fusion performed using the osteobiologic agent Osteocel, an allograft mesenchymal stem cell matrix. METHODS: The medical records across 3 medical centers and 12 spine surgeons were retrospectively queried for patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with the use of Osteocel. Pseudarthrosis was determined based on CT or radiographic imaging of the cervical spine. Patients were determined to have radiographic pseudarthrosis if they met any of the following criteria: 1) lack of bridging bone on CT obtained > 300 days postoperatively, 2) evidence of instrumentation failure, or 3) motion across the index level as seen on flexion-extension cervical spine radiographs. Univariate and multivariate analyses were then performed to identify independent preoperative or perioperative predictors of pseudarthrosis in this population. RESULTS: A total of 326 patients met the inclusion criteria; 43 (13.2%) patients met criteria for pseudarthrosis, of whom 15 (34.9%) underwent revision surgery. There were no significant differences between patients with and those without pseudarthrosis, respectively, for patient age (54.1 vs 53.8 years), sex (34.9% vs 47.4% male), race, prior cervical spine surgery (37.2% vs 33.6%), tobacco abuse (16.3% vs 14.5%), chronic kidney disease (2.3% vs 2.8%), and diabetes (18.6% vs 14.5%) (p > 0.05). Presence of osteopenia or osteoporosis (16.3% vs 3.5%) was associated with pseudarthrosis (p < 0.001). Implant type was also significantly associated with pseudarthrosis, with a 16.4% rate of pseudarthrosis for patients with polyetherethereketone (PEEK) implants versus 8.4% for patients with allograft implants (p = 0.04). Average lengths of follow-up were 27.6 and 23.8 months for patients with and those without pseudarthrosis, respectively. Multivariate analysis demonstrated osteopenia or osteoporosis (OR 4.97, 95% CI 1.51-16.4, p < 0.01) and usage of PEEK implant (OR 2.24, 95% CI 1.04-4.83, p = 0.04) as independent predictors of pseudarthrosis. CONCLUSIONS: In patients who underwent single-level ACDF, rates of pseudarthrosis associated with the use of the osteobiologic agent Osteocel are higher than the literature-reported rates associated with the use of alternative osteobiologics. This is especially true when Osteocel is combined with a PEEK implant.

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Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

June 2021

Volume

50

Issue

6

Start / End Page

E6

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Fusion
  • Retrospective Studies
  • Pseudarthrosis
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Female
  • Diskectomy
 

Citation

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Bergin, S. M., Wang, T. Y., Park, C., Rajkumar, S., Goodwin, C. R., Karikari, I. O., … Than, K. D. (2021). Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis. Neurosurg Focus, 50(6), E6. https://doi.org/10.3171/2021.3.FOCUS2166
Bergin, Stephen M., Timothy Y. Wang, Christine Park, Shashank Rajkumar, C Rory Goodwin, Isaac O. Karikari, Muhammad M. Abd-El-Barr, Christopher I. Shaffrey, Chester K. Yarbrough, and Khoi D. Than. “Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis.Neurosurg Focus 50, no. 6 (June 2021): E6. https://doi.org/10.3171/2021.3.FOCUS2166.
Bergin SM, Wang TY, Park C, Rajkumar S, Goodwin CR, Karikari IO, et al. Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis. Neurosurg Focus. 2021 Jun;50(6):E6.
Bergin, Stephen M., et al. “Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis.Neurosurg Focus, vol. 50, no. 6, June 2021, p. E6. Pubmed, doi:10.3171/2021.3.FOCUS2166.
Bergin SM, Wang TY, Park C, Rajkumar S, Goodwin CR, Karikari IO, Abd-El-Barr MM, Shaffrey CI, Yarbrough CK, Than KD. Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis. Neurosurg Focus. 2021 Jun;50(6):E6.

Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

June 2021

Volume

50

Issue

6

Start / End Page

E6

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Fusion
  • Retrospective Studies
  • Pseudarthrosis
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Female
  • Diskectomy